Breast Cancer - Arab Medical Association Against Cancer

First-line chemotherapyManagement of advanced breast cancer 181No prior CTX or12 mo since prior adjuvant CTX(ensure adequate cardiac functionif considering doxorubicin andpreviously treated)Different CTX than used in adjuvant(see Progress on first line or second line, below)AC, CMF, orsingle-agent taxane(paclitaxel, docetaxel)First-line nontaxaneProgress on first lineFirst-line taxaneerb-b2 overexpressedcandidate for paclitaxelTaxaneAC (see above) or CMFProgress on second lineVinorelbineCapecitabineLeucovorin / infusional 5FULiposomal doxorubicinEtoposide (VP16)Trastuzumab withpaclitaxel(do not give withdoxorubicin )Figure 10.2. Decision Algorithm for Patients with Metastatic Breast CancerTargeted therapyHER-2/neu, a new member of the group 1 growth factor receptor family, isamplified and /or overexpressed in 20% to 30% of patients with breast cancer.Overexpression of this oncogene product is associated with increased rates of tumorgrowth, enhanced rates of metastasis, shorter disease-free survival, and overallsurvival.As a single agent, trastuzumab produces complete and partial remission in 13% to20% of patients with metastatic breast cancer. In association with chemotherapy,trastuzumab enhances the response rate of the combination compared withchemotherapy alone and result in prolonged time to progression and increases 1-year survival rates. Trastuzumab is well tolerated, low-grade fever, chills, fatigue,and constitutional symptoms occur primarily with the first infusion, and serious